Governing Boards and Hospital Performance

Research Design

This study will use a quantitative methodology to measure governing board performance of two groups of hospitals. The quantitative methodology is preferred because the study will require specific data about the hospitals such as performance, governance and general management of the hospitals. A survey will ensure that all the data required is obtained and that the data is accurate. The hospitals to be surveyed will be non-profit hospitals operating in the United States. The two groups of hospitals to be included in the survey will be determined by the performance of the hospitals. The two groups will therefore be the high performing hospitals and the low performing hospitals (Taylor, et al. 1996).

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) will obtain the two groups depending on rankings of hospitals. This body is responsible for accrediting and ranking healthcare organizations. It is the national hospital ranking performance indicator and it ensures that all healthcare organizations conform to the set standards. The ranking of hospitals by JCAHO is accurate and reliable since the organization conducts on-site surveys in order to come up with the rankings. This assessment of the hospitals is done based on their standing on quality of care, efficiency, clinical effectiveness, staff, patient centered and governance response.

The high performing group will include only hospitals recognized with high performing status according to the rankings by JCAHO. Some hospitals have been found to conform to the healthcare standards largely. The low performance group will include hospitals that could not achieve high performance status of JCAHO yet these hospitals have national ranking scores that can be used for analytical purposes. These are hospitals found to be lagging behind in performance and in implementation of the healthcare standards.

Two groups of hospitals will be examined and compared depending on performance and implementation of healthcare standards. The first hospital sample will come from the 100 best hospitals in the United States in the 2011 hospital rankings. Hospitals will be selected from the 50 of the best of benchmark hospitals since only nonprofit hospitals will be used in this study. The sample is restricted to non-profit hospitals to maintain consistency with the research on nonprofit organizations. In addition, nonprofit hospitals are used since the governing boards of these hospitals operate on different premises from those of for-profit boards. The low performing hospitals are from a list of 100 nonprofit hospitals that did not make the best benchmark of hospitals (Totten & Orlikoff, 2006).

Convenience sampling will be utilized to identify hospitals to participate in the study. 100 healthcare organizations will be invited to participate in the study. This sample size is assumed a good representation of the survey population. Convenience sampling will be preferred in order to make the survey simple and cheap. Convenience sampling will involve collecting data from the hospitals within reach of the researcher. Hospitals from which the researcher can acquire information without straining much will be preferred. This will save on research time and cost. The research will seek consent and participation from as many hospitals as possible to achieve the target sample size. The researcher will also seek permission to access the websites of the non-profit hospitals participating in the study. This is because the research will utilize information about hospitals available in the hospitals’ websites. The permission will be sought from the CEOs of the hospitals to ensure that the research is within legal requirements (Poister & Streib, 2005).


The independent variables are the six-hospital board performance scores as measured by the BSAQ (Chait, 1993). Each hospital board member will complete a survey that determines the hospital score. The primary dependent variables are the five criteria of the hospital performance indicators that determine hospital ranking (JCAHO). These primary independent variables are categorized into elements of performance (EP) and environment of care (EC) standards. The second independent variables include detailed analysis of the five performance indicators to performance. The performance indicators used by JCAHO to rank hospitals are the human resource (HR) standards and the leadership (LD) standards. These hospital performance indicators can determine the JCAHO national hospital ranking given the detailed components of the primary dependent variables. Other variables to be used in the research are the academic qualifications of the hospital boards, strategic formulation, interpersonal skills and other attributes that have an effect in the success of an organization (Pointer & Orlikoff, 1999).

The dependent variable will be the overall performance of the hospitals. The research will examine the relationship between primary dependent variables and the performance of the hospitals. The research will consider the effects of the independent variables on the dependent variable. This comparative analysis will address the research question: Do better performing boards have better performing hospitals? (McDonagh, 2006).


The survey tool is the BSAQ that will measure governing board effectiveness in six areas of competency: Contextual, Educational, Interpersonal, Analytical, Political, and Strategic. The BSAQ tool is an assessment questionnaire consisting of 20 questions with answers in a 4-point Likert-type scale. The BSAQ tool has been used in over 300 nonprofit organizations, which provides a national database for comparison. To facilitate comparisons of finding this project will use the BSAQ procedure. The six items are used to measure board effectiveness based on the existing scale tailored to take account of the healthcare context. The respondents will be asked to provide objective rankings on the political effects, strategic management application, analytical skills, interpersonal skills and levels of education to the governance of the hospitals (Kovner, 1990).

There is potential bias in the study because the variables used in the study are largely objective. However, this bias is limited since the rankings used are done by the JCAHO hence they are free from bias. Response bias will be reduced by requesting the respondents to be objective in their responses. The respondents will be free not to answer any questions they might not feel comfortable with and this will reduce bias. Respondents might provide inaccurate and incomplete information due to lack of time hence adequate time will be provided to the respondents (Payne, et al. 2009).

The existing research tool used in this research has been tested for reliability, validity and sensitivity. The BSAQ will be used in over 200 nonprofit organizations, which will provide a database to facilitate comparison of findings. The BSAQ tool will be accessed via Web- based survey technology. Once the Hospital CEO’s of each hospital will give consent, the individual board member will receive instructions to access the Web site and complete a survey about their board’s effectiveness. The estimated time of completion will be 20 minutes. The consent to participate will be part of the survey process. Electronic survey will protect the board members confidentiality of information and the researcher access to the database. The BSAQ test will provide an opportunity for feedback on the questionnaire and the data collection process (Griffith, et al. 2002).


This correlation research study is designed to compare two groups: (a) nonprofit hospitals that will be identified as high performing hospitals and (b) a comparison group of hospitals that had not received recognition as being high performing. The comparison will be based on the elements of performance in health care and the governance of the hospitals. The elements for comparison and the analysis tool to be used in the study are JCAHO standards and the BSAQ tool of analysis respectively. The comparison is undertaken to provide a better understanding of the relationship between hospital board’s effectiveness and organizational performance (Orlikoff & Totten, 2003). This quantitative study will utilize the BSAQ questionnaire to measure governing g board performance in the study and the comparison groups of hospitals (Brown, 2005).

The study will strive to access accurate and reliable information about the hospitals participating in the study. Respondents will be requested to avoid bias in completing the questionnaires and they will be encouraged to give complete information. The sample size to be used is large enough to form a representation of the population. The research will ensure that it complies with the terms and conditions of use in handling the information about the hospitals participating in the study. The primary objective the research design, variables and instruments is to remain focused to the overall research objectives and to provide accurate data. This will ensure that the study is authoritative and legitimate.


Brown, W. (2005). Exploring the association between boards and organizational performance in nonprofit organizations. Nonprofit Management & Leadership, 15, 317-339.

Chait, R.P. et al. (1991). The effective board of trustees. Phoenix, AZ: Oryx Press.

Griffith, J.R. et al. (2002). Measuring comparative hospital performance. Journal of Healthcare Management, 47(1), 41-47.

Kovner, A.R. (1990). Improving hospital board effectiveness: An update. Frontier of Health Services Management, 63(3), 3-27.

McDonagh, J.K. (2006). Hospital governing boards: A study of their effectiveness in relation to organizational performance. Journal of Healthcare Management, 51(6)

Orlikoff, J.E. & Totten, M.K. (2003). What board should know about turnarounds? Trustee, 56(10).

Payne, G.T. et al. (2009). Corporate board attributes, team effectiveness and financial performance. Journal of Management Studies, 46(4) 707-731.

Pointer, D.D. & Orlikoff, J.E. (1999). Board work: Governing healthcare organizations. San Francisco: Jossey-Bass Publishers.

Poister, T.H., & Streib, G. (2005). Elements of strategic planning and management in municipal government: Status after two decades. Public Administration Review, 65 (1) 45-56.

Taylor, B.E. et al. (1996). The new work of the nonprofit board. Harvard Business Review , 74(5) 36-46.

Totten, M.K. & Orlikoff, P.O. (2006). Governance at the crossroads. Healthcare Executive, 21, 38-41.

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